Author: Zhang Zhong-Jing, 張仲景
Year: c. 220
Source: Discussion of Cold Damage (Shang Han Lun, 傷寒論)
Category: Formulas that Release the Exterior
Pattern: Externally contracted Wind-Dampness
Key Symptoms: Mild generalised body aches, slight aversion to drafts, fever that worsens in the afternoon.
Ingredients
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Ma Huang
| 1.5g | |
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Pinyin: Ma Huang
Chinese: 麻黄
Pharmaceutical: Herba Ephedrae
Taxonomy: Ephedra sinica seu intermedia seu equisetina
English: Ephedra Stem / Joint Pine / Joint Fir / Mormon Tea / Brigham Tea |
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Tastes: Pungent, slightly bitter, warm
Meridians Entered: Lung and Bladder |
Actions & Indications:
- Induces sweating and releases the Exterior
Taiyang Stage Wind-Cold Invasion of the Lung, with anhidrosis, chills, fever, headache and a tight, floating pulse
- Disseminates and facilitates Lung Qi, calms wheezing and stops coughing
Wind-Cold Obstructs Lung Qi
- Promotes urination and reduces oedema
Externally generated oedema
- Warms and disperses Cold pathogens
Wind-Cold Bi
Cold extremities (Reynaud's disease)
- Breaks up concretions, firmness, accumulations and gatherings (Shen Nong Ben Cao Jing)
Yin sores that are firm, deeply rooted and without a head
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Standard Dosage: 1.5-9g in decoction to release the exterior, and 10-15g for the treatment of oedema. Maximum dose is 20g. Toxic dose is considered to be 30-45g but side effects and risks are possible at any dosage.
Cautions: It is prohibited to be used for patients with deficient dyspnea without blockage of the lung qi and should be used with caution for patients with hypertension and insomnia because ephedrine can stimulate central nervous system and raise blood pressure. The Shang Han Lun recommends removing the nodes and decocting Ma Huang first, scooping the foam from the top of the decoction. It has been argued this is to reduce the "vexing" effects although the efficacy of this is debated and rarely done today.
It should not be used in conjunction with MAOIs, central nervous system stimulants, alkaloids ergotamines and xanthines enhancing their effects by acting as a receptor level agonist.
In the UK the maximum daily dose permitted without prescription is 1.8g daily in three 0.6g doses. This makes it difficult to achieve a pharmacologically active effect and must be complemented with other herbs that release the exterior and expel Wind-Cold such as Gui Zhi, Jing Jie, Fang Feng and Zi Su Ye.
Huang Hua Zi (Sida cordifolia), more common in Ayurveda where it is known as Bala बला, also contains ephedrine at lower concentrations and has no legal restrictions placed on it by the UK MHRA. It is considered more cooling, Heat clearing and Damp draining without Exterior Releasing properties in Chinese medicine so best used as a substitute in Warm Diseases, especially Damp-Warm Disease, or supplemented with increased warm Exterior Releasing herbs like those described above. |
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Xing Ren
| 3g | |
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Pinyin: Xing Ren
Chinese: 杏仁
Pharmaceutical: Semen armeniacae
Taxonomy: Prunus armeniaca seu mandshurica seu sibirica
English: Bitter Apricot Kernel |
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Tastes: Bitter, slightly warm, slightly toxic
Meridians Entered: Lung and Large Intestine |
Actions & Indications:
- Stops coughing and calms wheezing
Coughs due to either Heat or Cold (depending on combination) Wind-Dry coughs (especially useful)
- Moistens the Intestines and unblocks the bowels
Constipation
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Standard Dosage: 3-10g in decoction.
Cautions: It should not be overused for its slight toxicity. It should be used with cautions for infants and patients with diarrhea. |
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Yi Yi Ren
| 1.5g | |
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Pinyin: Yi Yi Ren
Chinese: 薏苡仁
Pharmaceutical: Semen Coicis
Taxonomy: Coix lacryma-jobi
English: Job's Tears / Chinese Pearl Barley |
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Tastes: Sweet, Bland, Slightly Cold
Meridians Entered: Spleen, Stomach and Lung |
Actions & Indications:
- Strengthens the Spleen and resolves Dampness
Dampness Stagnation or Spleen Deficiency Dampness with diarrhoea, leg Qi, painful urinary dribbling
Damp-Warmth (treats root and manifestations)
- Expels Wind-Dampness and relieves pain
Wind-Damp Bi (increases joint mobility and decreases spasms in chronic cases) for stiffness of the muscles, severe arthralgia and joint immobility
- Clears Heat and expels pus
Soft, pustulated carbuncles, Lung and Intestinal abscess
- Clears Damp-Heat
Any Damp-Heat condition at any level with a greasy, white tongue coat and digestive problems
- Aids fasting
Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of herbs which can, with protracted taking, make the body light and boost the Qi. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生). At ~70% carbohydrates (Zhu, 2017), this would represent one important source of of this nutrient class which could be had in the amounts that could be foraged, as opposed to farmed, to maintain this kind of diet long term. Its root is also suggested to expel the Three Worms.
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Standard Dosage: 9-30g in decoction.
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Gan Cao
| 3g | | |
Pinyin: Gan Cao
Chinese: 甘草
Pharmaceutical: Radix Glycyrrhizae
Taxonomy: Glycyrrhiza uralensis seu glabra seu inflata
English: Liquorice Root |
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Tastes: Sweet, slightly cold
Meridians Entered: Heart, Lung and Spleen (and all 12 meridians) |
Actions & Indications:
- Tonifies the Spleen and augments Qi
Spleen Qi Deficiency with shortness of breath, lassitude and loose stools
Qi and Blood Deficiency with an irregular pulse and/or palpitations
Heart Qi Deficiency or Heart Yang Deficiency
- Moistens the Lungs, resolves Phlegm and stops coughing
Lung Heat or Cold
Productive or non-productive coughing
- Moderates spasms and alleviates pain
Painful muscle spasms of the abdomen and legs
- Clears Heat and relieves Fire Toxicity
Raw for Toxic Heat with sore throat or carbuncles and sores (Chuang Yung)
- Antidote for many toxic substances (internal and topical)
Poisoning
Bites (after washing the wound, chew Gan Cao and apply a thick layer on the bite wound, changing whenever it dries out; Bao Xiang-Ao, 1846, New Compilation of Proven Formulas)
- Moderates and harmonizes the harsh properties of other herbs and guides the herbs to all twelve channels
Often added in small doses to harmonise formulas
- Tonifies the Qi while suppressing Parasites
Gu Sydnrome (Fruehauf, 1998)
Chronic inflammatory disease (Fruehauf, 2015)
- Aids fasting
Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of herbs which can, with protracted taking, make the body light and prolong life. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).
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Standard Dosage: Typically 1.5-9g in decoction. Large doses can be up 30g.
Cautions: It is contraindicated for combining with Hai Zao, Da Ji, Gan Sui and Yuan Hua because of "eighteen antagonisms". It is also contraindicated in cases of dampness obstruction in middle energizer and edema because it can help dampness obstruct qi, and it is prohibited from long-term usage in large dosage (more than 20g/day) and should be avoided or used with extreme caution in patients with high blood pressure because it may raise aldosterone levels in the blood causing retention of sodium.
The NHS recommends avoiding during pregnancy. |
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Subsitutions:
The low doses in this formula indicate a mild pattern. For more severe presentations individual herbs may be increased. Since Ma Huang is below the legal limit of 1.8g per day and a maximum dose of 0.6g per administration this does not need to be substituted but if it is to be increased it must be done with other warm exterior releasing herbs like Zi Su Ye, Jing Jie and Fang Feng.
Preparation: Decoction.
Actions: Releases the Exterior and dispels Wind-Dampness
Notes:
In order to mitigate the agitation causing effects of Ma Huang it may be fried in honey first and when decocted the froth removed from the surface with a spoon.
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One liang is taken as 3g in modern sources but in Eastern Han times it was equivalent to 13.875g. This means that the dosages in classical formulae could have been more than 4x what is given today making them far higher than recommended safe dosages today but prompts consideration of what an effective dose may be (He, 2013).
Research Links:
Reference Notes: (click to display)
Most formulas are found in Scheid, Bensky, Ellis & Barolet (2009): Chinese Herbal Medicine: Formulas & Strategies and Chen & Chen (2015) Chinese Herbal Formulas and Applications. Others are from translations of primary sources. It is recommended that the original material is cross-referenced for mistakes and additional information.
Substitutions have been taken from Ken Lloyd & Prof. Leung (2004): Mayway UK Substitution List or the above publications and are intended as suggestions to help navigate the tight restrictions in the UK quickly. More applicable substitutions may be appropriate in specific situations.
Individual herb information has initially been sourced from TCM Wiki and American Dragon for basic data and then updated manually with my own notes.
These pages are intended to assist clinicians and are not intended for self-diagnosis or treatment for which a qualified professional should be consulted.